Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs, Victoria N; Champaneria, Rita; Palmer, Antony; Dorée, Carolyn; Estcourt, Lise J

doi:10.1002/14651858.cd013295

Cited by 14 publications

(13 citation statements)

References 47 publications

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“…Network meta‐analyses are under way to determine an optimal dosing regimen to standardize clinical care and guide comparators for future research. Potential advantages of topical delivery are that it may overcome contraindications such as renal disease owing to lower plasma levels. Repeat doses to maintain therapeutic levels may play a greater role in prolonged surgery or where a large volume of blood is lost.…”

Section: Surgical Strategiesmentioning

confidence: 99%

“…Administration may be repeated during the intraoperative and postoperative phases. Network meta‐analyses are under way to determine an optimal dosing regimen to standardize clinical care and guide comparators for future research. Potential advantages of topical delivery are that it may overcome contraindications such as renal disease owing to lower plasma levels.…”

Section: Surgical Strategiesmentioning

confidence: 99%

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Strategies to minimize intraoperative blood loss during major surgery

Shah

Palmer

Klein

2020

British Journal of Surgery

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Background Reducing operative blood loss improves patient outcomes and reduces healthcare costs. The aim of this article was to review current surgical, anaesthetic and haemostatic intraoperative blood conservation strategies. Methods This narrative review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in the surgical patient. Results Interventions can begin early in the preoperative phase through identification of patients at high risk of bleeding. Directly acting anticoagulants can be stopped 48 h before most surgery in the presence of normal renal function. Aspirin can be continued for most procedures. Intraoperative cell salvage is recommended when anticipated blood loss is greater than 500 ml and this can be continued after surgery in certain situations. Tranexamic acid is safe, cheap and effective, and routine administration is recommended when anticipated blood loss is high. However, the optimal dose, timing and route of administration remain unclear. The use of topical agents, tourniquet and drains remains at the discretion of the surgeon. Anaesthetic techniques include correct patient positioning, avoidance of hypothermia and regional anaesthesia. Permissive hypotension may be beneficial in selected patients. Promising haemostatic strategies include use of pharmacological agents such as desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic haemostatic assays. Conclusion Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high‐quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited.

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Section: Surgical Strategiesmentioning

confidence: 99%

Section: Surgical Strategiesmentioning

confidence: 99%

Strategies to minimize intraoperative blood loss during major surgery

Shah

Palmer

Klein

2020

British Journal of Surgery

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“…Any patient with complications of volume overload can be treated with therapeutic plasma exchange [ 18 ]. Antifibrinolytic, such as ε-aminocaproic acid or tranexamic acid, fibrin glue, recombinant factor VIIa or factor XIII, and desmopressin can also be used in the treatment to minimize bleeding during surgery [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

A Case Report on an Extremely Rare Disease: Factor XI Deficiency

Mandal¹,

Gami²,

Shah³

2020

Cureus

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Factor XI deficiency is a rare condition with an estimated prevalence of about one in one million and is more commonly seen in Ashkenazi Jews (8-9%) due to consanguinity. It occurs because of mutations in the factor XI gene (F11) on chromosome 4(4q35). Patients with this disorder may remain asymptomatic until they undergo any surgical procedure or delivery. The most common sites of bleeding include the oral cavity, pharynx, and genitourinary tract, where there is high fibrinolytic activity. Our patient was asymptomatic his whole life. He never had spontaneous bleeding or bruising; however, he had severe bleeding requiring multiple transfusions of fresh frozen plasma during and after surgeries.

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“…However, the optimal dose, route and timing of administration of tranexamic acid is less clear. Network meta‐analyses are currently underway to identify an optimal peri‐operative dosing regimen to standardise clinical care . Both tranexamic acid and cell salvage are now key components of a multimodal patient blood management strategy.…”

mentioning

confidence: 99%

“…Data on the use of tranexamic acid and whether hospitals had established patient blood management programmes are also not shown. Tranexamic acid safely reduces blood loss and red blood cell transfusion requirements across multiple surgical specialties and it is now included in the World Health Organization list of ‘essential medicines’ . However, the optimal dose, route and timing of administration of tranexamic acid is less clear.…”

mentioning

confidence: 99%